Category Archives: Health Care

Personnel Shortages that Plague Virginia’s Health Facilities Inspection Staff in the Hands of Budget Negotiators

UVa Hospital

by James C. Sherlock

One of the most important responsibilities of Virginia state government is to inspect medical facilities and home care providers to ensure we are safe when we enter their care.

It continues to fail in that responsibility thanks to years of Virginia budgets that have consciously ignored the need for increased inspector staff and increased salaries with which to competitively hire that staff.

I have reported for a long time that the staffing of the Virginia Department of Health (VDH) Office of Licensing and Certification (OLC) is scandalously deficient. Based upon an update today from OLC, it remains so.

That organization has only half of the inspectors it needs to carry out its defined responsibilities.

Those highly skilled and very dedicated people, largely registered nurses, are asked to do every day for Virginians what we cannot do for ourselves and what our elected representatives have refused for decades to properly fund them to do.

Think of that next time you use the facilities and home providers they are required for your safety to inspect.

We hope the current General Assembly budget negotiators keep it in mind for themselves and their families.

Or the Governor sends the budget back until they do. Continue reading

TAVR Tuesday and Barbecue Thursday

by Steve Haner

Fourteen nights in a hospital, especially if you are fully awake and observant, is very instructive. Here are some things I want to share:

The hospitals are understaffed and otherwise under major stress, to the point that patient standards of care have changed. As nice and diligent as everyone is, nurses or technicians can be with only one patient at a time, and the charting they must do is extensive.

When the order for a vital test is placed at 11 a.m. and it finally happens at 2 a.m. the next morning, with two lonely techs running the CT machine through the dead of night, that’s about staffing. A 3 a.m. room visitor coming to conduct an ultrasound at bedside is a sign that team is also shorthanded.

A slow response on a call button is about staffing, not inattention at the desk. The days when the staff makes sure every patient gets at least cleaned up with wipes and gets clean sheets and a new gown daily are gone. It happens if you ask and happens quicker if a family member can help you. Continue reading

Virginia Supreme Court Gives Hope to Competitors of Regional Healthcare Monopolies

Reese Jackson, CEO, Chesapeake Regional Medical Center

Is the Virginia Antitrust Act now in play?

by James C. Sherlock

There is good news this morning for those of us hoping for more competition to regional healthcare monopolies in Virginia.

The Virginia Supreme Court (the Court) overturned the decision of the State Health Commissioner to deny the application of the Chesapeake Regional Medical Center (CRMC) to create an open heart surgical service.

Sentara Health, unsurprisingly, objected to the application and was a party to the case before the Court. It also had been a party to the hearing by the Virginia Department of Health (VDH) COPN (Certificate of Public Need) adjudication officer. That official then made a recommendation against CRMC that the health commissioner accepted. The court found his decision to be fatally flawed.

The Court remanded the original decision to the new health commissioner for re-consideration. In doing so, it overturned decisions by the Chesapeake Circuit Court (made by a visiting Norfolk judge who failed to disclose a conflict of interest) and by the appeals court that upheld that original decision.

The court found that the health commissioner made an error of law and that the courts erred in both:

  • deferring to the heath commissioner for interpretation of his agency’s own regulations without rigorous review of those regulations by the courts; and
  • applying the harmless error doctrine to that error of law.  

Continue reading

Improving Petersburg Public Health is a State Issue as Well as a Local and Personal Responsibility

By James C. Sherlock

The RTD today published an article “Petersburg is Virginia’s least healthy locality, and money is a big reason why” about one of my favorite subjects – the stubborn health problems in Petersburg and other poor urban areas of Virginia.

The story references the latest annual study from the University of Wisconsin Population Health Institute that ranks localities in Virginia from 1 to 133 in both health outcomes and health factors.

Residents of Petersburg, where the median household income is among the lowest in the state, face a life expectancy of only 66.2 years, the lowest in the state and 10 years worse than the national average, according to a study from the University of Wisconsin Population Health Institute that was circulated by the Virginia Department of Health.

It has ranked as the state’s least healthy locality in eight of the past 10 years.

The RTD headline attibutes those results to lack of money.   But the headline is nonsense.

We can and should do far better with the government assets and funded programs already in place to help Petersburg.

Continue reading

Unionize Virginia’s Worst Nursing Home Chains

by James C. Sherlock

If you go back to the series of articles I published here in October of 2021, you can refresh your memory on the dangers represented by Virginia’s worst nursing home chains.

If you look at the complete spreadsheet of every Virginia nursing home from that data sorted by ownership, the bad actors jump off the page. Their business models treat understaffing as a feature, not a problem. The fact that it endangers their employees and kills their patients seems not to matter.

The Commonwealth’s executive and legislative branches have for a very long time absolutely ignored their responsibilities as the state legislature and as the state executive regulator, federal and state inspector and state licensor of nursing homes, respectively. There is as yet no sign that will improve. I have hopes the new administration will step up to those responsibilities, but we’ll have to wait and see.

For now, the only fix that appears viable is unionization of the work forces of the bad actors. I encourage their employees to do it for themselves and their patients. Continue reading

Fix the Virginia Department of Health

Credit: PBS Healthcare Management

by James C. Sherlock

Governor Youngkin and his new administration have an opportunity to fix crucial problems in the Department of Health that have been festering for decades.

The issues:

  • How can Virginia regulate effectively its state-created healthcare monopolies?
  • In a directly related matter, how can we fix the failures, famously demonstrated during COVID, of the Virginia Department of Health (VDH) in its other missions ?

The power of Virginia’s Certificate of Public Need (COPN) to control the business of healthcare in Virginia was the original sin.  Giving that power to the Department of Health made it worse.

From that point VDH was the agent of its own corruption. Never charged by the General Assembly to create regional monopolies in its administration of Virginia’s Certificate of Public Need (COPN) law, VDH did so anyway.

Actions have consequences.

Now those regional healthcare monopolies are each the largest private business in their regions, have achieved political dominance in Richmond, and effectively control VDH. Continue reading

Things Are Not Always As Intuitive As They May Seem

Photo credit: CNBC

by Dick Hall-Sizemore

Sometimes, public policy proposals can be counterintuitive.

Virginia law authorizes health insurance companies to charge smokers up to 50% greater than the premium that would otherwise be effective. The 2022 General Assembly passed legislation that would have repealed this authorization. The bills, HB 675 (Hope, D-Arlington) and SB 422 (Edwards, D-Roanoke), passed both houses with strong bipartisan majorities.

The Governor vetoed them.  His explanation for the vetoes was:

Smoking and tobacco use are among the leading causes of chronic health problems that result in higher healthcare costs. This legislation would force insurance companies to recover costs associated with tobacco users by raising premiums on non-tobacco users. The ability to reduce premiums by quitting smoking is also a valuable incentive to encourage healthier habits.

Requiring non-tobacco users to cover the increased healthcare costs associated with tobacco use is not a policy I can support.

On its face, this explanation sounds reasonable. After all, society should discourage smoking and no one wants to subsidize unhealthful habits. Continue reading

Pill-Popping Nurse Gets Three Years in Prison

by Kerry Dougherty

If there’s a special ring in hell for those who prey on children — and I hope there is — there should also be a place reserved for those who hurt the elderly.

Consider the monstrous acts of Janeen Bailey, a 57-year-old LPN with 25 years of nursing experience who stole painkillers from elderly patients in two long-term care facilities and used the drugs to relieve her own discomfort while they writhed helplessly in pain.

According to news reports, Bailey told investigators she believed the patients could cope with their own pain better than she could with hers because she was working and they were not. The nurse allegedly suffered from back pain.

Bailey denied she was an addict.

She pleaded guilty to two counts of tampering with a consumer product.

Seriously?

That’s the most serious charge prosecutors could concoct? Continue reading

Virginia’s COVID Performance Rates a D

Source: The Committee to Unleash Prosperity

by James A. Bacon

Virginia performed worse than 35 other states during the COVID-19 recession, based on an analysis that encompasses mortality rates, economic performance and educational performance. The Commonwealth fared better than average in health outcomes, worse than average in economic performance, and near the bottom in school closures. The overall ranking: D.

Nationally, there was little correlation, however, between the stringency of economic and school-related COVID lockdowns and health outcomes, finds the study, “A Final Report Card on the States’ Response to COVID-19,” published by the National Bureau of Economic Research. The authors were Phil Kerpen, Stephen Moore, and Casey B. Mulligan, all well-known free-market economists.

Former Governor Ralph Northam, a physician, can take some comfort in the fact that Virginia under his watch performed better than most other states in the COVID-related mortality rate when adjustments were made for age and the prevalence of obesity and diabetes risk factors in the population — 10th best in the nation.

However, when the perspective shifts to “all cause excess deaths,” which captures the mortality effects of lockdown policies such as higher drug and alcohol deaths, suicides, and foregone medical treatments, Virginia’s national ranking falls to 19th. Continue reading

CMS Finally Withdraws Dangerous Waivers of Nursing Home Patient Safety Regulations

by James C. Sherlock

I published a series of articles last year on the dreadful conditions in some of Virginia’s nursing homes as reported by Medicare.

Two key observations were that:

  • bad nursing homes were traceable to specific chain operators; and
  • the Virginia Department of Health had admitted it was desperately short of inspectors.

Those two things are still true.

A major problem at that time was that nursing homes were provided an extensive set of waivers of patient safety regulations by the Centers for Medicare/Medicaid Services (CMS). Those “COVID” waivers were overdone when granted and have been in place far too long.

This is a really big deal. CMS admits “mistakes were made” with waivers that endangered patients.

They are finally scheduled to be withdrawn. Continue reading

The Relentless Push for Child Gender Transition

Dr. Rachel Levine, U.S. Assistant Secretary of Health

by James C. Sherlock

On the odd chance you missed it, the Biden administration announced a flurry of new measures today, designated the Transgender Day of Visibility. (I need to keep up.)

The Washington Post reported on the festivities. What that story did not report is the celebration’s most important “feature.”

HHS today announced Biden administration support for gender transition  for children.

For transgender and nonbinary children and adolescents, early gender-affirming care is crucial to overall health and well-being as it allows the child or adolescent to focus on social transitions and can increase their confidence while navigating the healthcare system.

Happy to know that HHS defines this as “gender-affirming” care — “affirming” and “care” are cute terms — “at any age or stage” of development. Continue reading

What Virginia Can Do to Temper Inflation


by James A. Bacon

Governor Glenn Youngkin has proposed using $437 million in unanticipated transportation revenues, much of it generated by the wholesale tax on gasoline, to give Virginians a three-month break on the 26-cent retail gasoline tax.

During his campaign, Youngkin ran on a platform of addressing Virginia’s high cost of living and reversing the erosion of middle-class living standards. A vacation on the gasoline tax is certainly consistent with that theme. And with inflation running at nearly 8% over the past 12 months, Virginians need help wherever they can find it. They will find no succor from Democrats, whose list of unmet societal “needs” is endless. They are delighted to spend every dime in tax revenue on one of their favored causes — which, alas, rarely includes helping financially strapped middle-class taxpayers.

While Youngkin has identified a winning issue, he needs to think bigger and more systematically. It’s fine to dial back the gasoline tax for a time, remove the sales tax on groceries, and try to repeal the Regional Greenhouse Gas Initiative (RGGI) carbon tax, but there is so much more that he can do.

Forty-one percent of the cost of living, as calculated by the Bureau of Labor Statistics, is housing, 17% transportation, 7% medical care, and almost 7% education. Each of these categories is, to some degree, influenced by state-level budgetary and regulatory policy. Continue reading

A Narrative About Virginia’s Rural Hospitals that Obscures the Facts

by James C. Sherlock

Becker’s Healthcare, a widely read medical news organization, published a story on Friday, “892 hospitals at risk of closure, state by state.” Rural hospitals were the topic.

It cited as its source a report from a non-profit named The Center for Healthcare Quality and Payment Reform (CHQPR), which presents itself as “a national policy center that facilitates improvements in healthcare payment and delivery systems.”

The CHQPR report Rural Hospitals at Risk of Closing claims that twelve of Virginia’s “27″ rural hospitals are at immediate risk of closing. It certainly engaged my interest.

Another CHQPR report, The Crisis in Rural Health Care, has an interactive map where the twelve perhaps can be found.

But the sources of both reports are a mystery, at least to me.

  • First it must be noted that the Virginia Department of Health lists only 20 rural hospitals in the state.
  • Only five of them lost money in 2020 (see the column “Revenue and Gains in Excess of Expenses and Losses”).
  • Four of those are owned by large and profitable health systems that use them to feed more profitable cases to other system hospitals.

It is dangerous to the cause of improving rural healthcare to create “reports” like this. Continue reading

Primary Care Shortages in Virginia and an HEZ solution

by James C. Sherlock

I have written here and in newspapers across the state with a recommendation that Virginia emulate Maryland in the establishment of Health Enterprise Zones (HEZs) to bring primary care to Virginia communities that lack sufficient access to treat people before their conditions require hospitalization.

Here I will provide data on Virginia primary care needs calculated separately for health outcomes and for health professional shortages.

You will not be surprised to learn the locations with the measured shortages of primary care physicians do not exactly align with the areas with the worst health outcomes. That proves what we knew already. There are other factors in play in health outcomes.

But we know absolutely that more primary care professionals in communities targeted for both criteria can both improve outcomes and greatly lower Medicaid costs. Continue reading

New York Governor Removes Mask Requirement for School Kids – Virginia Mask Advocates Confused

CDC Director Rochelle P. Walensky, MD, MPH

by James C. Sherlock

Headline: “New York City says it will end the school mask mandate and indoor vaccination requirements.AndNew York indoor school mask mandate to be lifted this week.

Progressive Virginians have been stabbed in the back. Et tu, New York?

So, imagine you have filed a law suit against Governor Youngkin on the same issue.

When you have lost New York, not to mention The New York Times, CNN and the CDC, what is a righteous science follower to do?

COVID-19 County Check

In Virginia Beach County, Virginia, community level is Low.

Watch this space for the self-flagellation, rending of garments and desperate references of the woke.